Wiki Which Insurance to bill with COB Update?

[ahrx13]

Hello!! I am hoping to get some guidance on which insurance to bill when a patient updates their coordination of benefits and it turns out they had a different insurance primary at the time. Most of the time our services require authorization, so of course when I bill the new Primary insurance it denies for no authorization or being a non-covered service. I have been taking this EOB and billing the former primary (now secondary) insurance since that is where we have authorized the service and they originally paid and recouped payment.
Is this the right path to take? Or do I appeal the claim with the new primary insurance with the reasoning that the patient didn't update COB until after the service was performed so we couldn't have gotten authorization/known a service would be covered? Any help would be appreciated!

 

[CBLENNIE]

Or do I appeal the claim with the new primary insurance with the reasoning that the patient didn't update COB until after the service was performed so we couldn't have gotten authorization/known a service would be covered? Any help would be appreciated!

I work for a payer and this is the approach I would recommend. I would send proof of the now secondary payer's EOB and PA approval letter with the appeal to show you had good cause for failing to obtain the PA from what is now the primary payer.

 

[csperoni]

I agree with @CBLENNIE - the secondary will not pay as primary simply because you authorized it through them. The primary is the primary and you have justification for why auth wasn't obtained.

 

[ahrx13]

Thank you, I appreciate your responses!!